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WASHINGTON — The amount of opioid painkillers prescribed in the United States peaked in 2010 and has been declining, a new federal analysis has found.

But the analysis, by the federal Centers for Disease Control and Prevention (CDC), also found that the prescribing rate in 2015 remained three times as high as in 1999, when the nation’s problem with opioid addiction was just starting. And there is still tremendous regional variation in how many opioids doctors dole out, with far more prescribed per capita in parts of Maine, Nevada and Tennessee, for example, than in most of Iowa, Minnesota and Texas.

Nationally, the analysis found that the amount of opioids prescribed fell 18 percent from 2010-15, though it increased in 23 percent of the counties.

Painkiller pulled from market

Endo International, the maker of opioid painkiller Opana ER, is pulling the drug off the market at the request of federal regulators because it’s being abused. The company said

Thursday it will voluntarily stop selling the pills, approved for use in patients with severe, constant pain, after consulting Food and Drug Administration (FDA). It’s the first opioid drug that the FDA has sought to remove from the market due to abuse.

The Associated Press

“We still have too many people getting medicine at too high a level and for too long,” said Dr. Anne Schuchat, acting director of the CDC. She noted that the quantity of opioids prescribed in 2015 would be enough to provide every American with round-the-clock painkillers for three weeks.

Washington state mirrors the overall prescription decline. It also follows the national trend of highest prescription rates in more rural counties, with lower income levels, higher percentages of white residents and more unemployed people.

But the percentage of Washington counties that saw an increase in prescriptions, 13 percent, was well below the national average.

The number of Washington counties with high prescription rates is also considerably fewer than in West Virginia, which has been hit especially hard by the opioid epidemic.

In King County, opioid prescriptions decreased by 34 percent from 2010 to 2015, according to the study. Snohomish County saw a 17 percent decline.

The average daily amount prescribed in King County was roughly one-quarter of the amount in Asotin County, Washington’s highest-prescribing county, according to the study. The CDC uses a measure of morphine milligram equivalents in its analysis.

A flurry of recent attempts to tamp down opioid prescribing — including CDC guidelines issued last year on prescribing the drugs for chronic pain and new state and insurer limits on how many pills doctors can prescribe — are not reflected in the analysis, which did not look beyond 2015.

But earlier actions, like state crackdowns on pain clinics and prescribing guidelines released by the Department of Veterans Affairs in 2010, may have contributed to the declines. The quantity of prescribed opioids fell in 85 percent of Ohio counties from 2010-15, for example, as the state tightened regulations for pain clinics and started requiring clinicians to check databases to see whether patients were getting opioid prescriptions elsewhere.

The decline documented in the analysis also coincided with the federal government’s tightening of prescribing rules in 2014 for one of the most common painkillers: hydrocodone combined with a second analgesic, such as acetaminophen.

In many states, including Ohio, restrictions on prescribing have coincided with staggering increases in overdose deaths from heroin and its far more powerful, synthetic relative, fentanyl. But Schuchat, pointing to several studies, said the CDC had found no clear-cut evidence that tighter prescribing played a role in the rising use of illicit opioids.

“We do know that when you start people on prescription opioids, the risk of unintended consequences and illicit use goes up,” Schuchat said. “But our staff has done intensive analyses to see whether changing policies for prescription drugs shifts people into illicit use, and the answer is no.”

While the analysis found that the amount of opioids prescribed per capita remained extremely high in many counties in 2015, some experts warned that averages could be misleading.

“An enormous amount of opioid volume is driven by a very small number of prescribers,” said Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “They need to be intervened upon, targeted with educational outreach and, if necessary, professional or regulatory sanction. My sense is that’s not yet happening enough.”

“One group I think has been affected without question is patients who are compliant with their regimen, who have a clear diagnosis and have been managed appropriately, but now find they can’t continue to receive opioids that allowed them to continue to function,” said Dr. Daniel Carr, director of Tufts Medical School’s program on pain, research education and policy.

But others say there is little evidence to suggest opioids are effective for chronic pain that is not caused by cancer. “If you are on opioids longer than three months, your risk of being addicted increases by 15-fold,” Schuchat said.

The CDC analysis, which used retail prescription data from QuintilesIMS, also found that larger amounts of opioids were prescribed in “micropolitan” counties, which have urban clusters of 10,000 to 50,000 people and are often anchor communities for much larger rural regions. It also found that larger amounts were prescribed in counties with higher prevalences of diabetes and arthritis, larger white populations, higher unemployment and higher Medicaid enrollment.

Despite the national decline in the amount of opioids prescribed, the analysis found that the average number of days that opioid prescriptions were meant to last increased in 73 percent of the counties from 2010-15. Overall, the average supply grew about 14 percent, from 15.5 to 17.7 days’ worth. Schuchat said that could be because fewer doctors were starting new patients on opioids — initial prescriptions are often smaller — and doctors instead were prescribing largely to longtime pain patients.

One weakness of the study, as Carr and the CDC researchers pointed out, was that it could not evaluate the reasons for prescriptions, and how often they were given for chronic pain versus acute or end-of-life pain.

The analysis also did not include opioid prescribing data from about 13 percent of the nation’s counties because it was not complete or available.